Department of Neurosurgery, Merheim Hospital, Ostmerheimer Str. 200, 51109, Cologne, Germany.
Faculty of Health, Herdecke University, WittenWitten, Germany.
Acta Neurochir (Wien). 2024 Mar 26;166(1):151. doi: 10.1007/s00701-024-06044-8.
This study aims to define specific measurements on cranial high-resolution computed tomography (HRCT) images prior to surgery to prove the feasibility of the navigated transmastoid infralabyrinthine approach (TI-A) without rerouting of the facial nerve (FN) and decompression of the jugular bulb (JB) in accessing the extradural-intrapetrous part of petrous bone lesions located at the petrous apex and petroclival junction.
Vertical and horizontal distances of the infralabyrinthine space were measured on cranial HRCT images prior to dissection. Subsequently, the area of access was measured on dissected human cadaveric specimens. Infralabyrinthine access to the extradural part of the petrous apex and petroclival junction was evaluated on dissected specimens by two independent raters. Finally, the vertical and horizontal distances were correlated with the area of access.
Fourteen human cadaveric specimens were dissected bilaterally. In 54% of cases, the two independent raters determined appropriate access to the petrous apex and petroclival junction. A highly significant positive correlation (r = 0.99) was observed between the areas of access and the vertical distances. Vertical distances above 5.2 mm were considered to permit suitable infralabyrinthine access to the extradural area of the petrous apex and petroclival junction.
Prior to surgery, vertical infralabyrinthine distances on HRCT images above 5.2 mm provide suitable infralabyrinthine access to lesions located extradurally at the petrous apex and petroclival junction via the TI-A without rerouting of the FN and without decompression of the JB.
本研究旨在术前对颅高分辨率 CT（HRCT）图像进行特定测量，以证明导航经乳突下迷路内进路（TI-A）在不重新走行面神经（FN）和不减压颈静脉球（JB）的情况下到达位于岩尖和岩斜交界处硬膜外-岩内骨病变的可操作性。
在解剖前，测量颅 HRCT 图像上的迷路下垂直和水平距离。随后，在解剖的人体尸体标本上测量进入的面积。由两名独立的评估者对解剖标本进行迷路下入路到达岩尖和岩斜交界处硬膜外部分的评估。最后，将垂直和水平距离与进入面积相关联。
对 14 个人体尸体标本进行了双侧解剖。在 54%的病例中，两名独立的评估者确定了到达岩尖和岩斜交界处的适当进入路径。进入面积与垂直距离之间存在高度显著的正相关关系（r=0.99）。垂直距离大于 5.2mm 被认为可以通过 TI-A 进行合适的迷路下入路，以到达岩尖和岩斜交界处的硬膜外区域。
术前 HRCT 图像上的垂直迷路距离大于 5.2mm 时，通过 TI-A 可在不重新走行 FN 和不减压 JB 的情况下，为位于岩尖和岩斜交界处硬膜外的病变提供合适的迷路下入路。
